1

Barriers and facilitators for children with special

educational needs education during the COVID-

19 pandemic

A systematic literature review in 2020

COURSE: One Year Master Thesis in Intervention in Childhood

PROGRAMME: Intervention in Childhood

AUTHOR: Álvaro Merello

TUTOR: Lilly Augustine

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SCHOOL OF EDUCATION AND COMMUNICATION (HLK) Jönköping University

Master Thesis 15 credits Interventions in Childhood Spring Semester 2021

ABSTRACT

Author: Álvaro Merello

Barriers and facilitators for children with special educational needs education during the COVID-19 pandemic.

A systematic review.

Pages: 28

Although COVID-19 has undoubtedly altered the lives of most human beings, one could argue that the education of children with special needs has been drastically affected. Measures taken by governments and consequences of the pandemic per se have changed the notion of traditional education shifting it to a virtual plane. A total of 6 articles extracted from different databases were included in this systematic review. The aim was to explore the literature on special education and the development of children with special educational needs in relation to the barriers and facilitators they have encountered in coping with the pandemic. Findings show a significant difference between the number of facilitators and barriers found. The high number of barriers in the environment, activities and participation and mental functions, gives an overview of the obstacles that children with special educational needs have faced during the pandemic. Most of the barriers encountered appeared to be interrelated and have reshaped the way education is understood. To address this problem and try to overcome the challenges they pose, efforts must be made at higher levels of society, such as policies, laws, or government support, to ensure the proper development of children.

Keywords: children, special education, COVID-19, barriers, facilitators, teachers, digital transition.

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Contents

Contents ______________________________________________________________ 3

1. Introduction _________________________________________________________ 4

1.1 Bronfenbrenner’s Bioecological Model of Human Development ______________________ 6

1.2 ICF-CY _________________________________________________________ 8

2. Purpose __________________________________________________________ 11

3. Method ___________________________________________________________ 11

3.1 Systematic review __________________________________________________ 11

3.2 Search Procedure ___________________________________________________ 11

3.3 Inclusion/Exclusion criteria ___________________________________________ 12

3.4 Selection process ___________________________________________________ 13

3.5 Data extraction ___________________________________________________ 15

3.6 Quality assessment _________________________________________________ 16

4. Results ___________________________________________________________ 16

4.1 Facilitators ______________________________________________________ 19

4.2 Barriers ________________________________________________________ 20

5. Discussion _________________________________________________________ 24

5.1 Reflections on findings _______________________________________________ 25

5.2 Bronfenbrenner theory _______________________________________________ 27

5.3 Method and limitations ______________________________________________ 29

5.4 Future research ____________________________________________________ 30

6. Conclusion ________________________________________________________ 30

7. References _________________________________________________________ 32

Appendix ____________________________________________________________ 38

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1. Introduction

During centuries humankind have faced several pandemics that have shaped human history.

A pandemic can be described as an “outbreak of infectious disease that occurs over a wide

geographical area and that is of high prevalence, generally affecting a significant proportion

of the world’s population, usually over the course of several months” (Rogers, 2020). A

pandemic differs from an epidemic, as for the last one it is also an outbreak of infectious

disease, but it remains in one geographical zone (Editors of Encyclopaedia Britannica, 2020).

Among the biggest pandemics that the world has face, we have the Black Death (1346-1353)

and the Spanish Flu (1918). Pandemics not only presents themselves as a health crisis, but it

also affects different spheres of our society such as economy, culture, or social areas, possibly

bring devasted effects to them. Countries must adapt to the different situations in order to

countereffect the outcomes that a pandemic can cause inside their territories.

During 2020 the world experienced a pandemic of proportions that have not

happened in decades. It shown itself to the world during the end of 2019 and was named

Coronavirus (COVID-19) or SARS-CoV-2. An infectious disease that affects the respiratory

system with a highly contagious rate (World Health Organization, 2020a). The official

numbers for this disease are alarming, as in the moment this moment-8th of February of

2021-COVID-19 has already infected 105.658.476 people all over 223 countries with an

ongoing death toll of 2.309.370 people (WHO, 2021).

Following the timeline provided by the World Health Organization (2020b), on

December 2019 was the first time the virus was reported in China taking almost four months

to be declared a pandemic by the WHO. During this period of time, different countries have

taken different measures, following health recommendations from different organizations,

in order to avoid the spread of the virus, measures like lockdowns, curfew, timetables

restrictions, closing schools, among others. Measures that in some countries are still going

on or even become more restrictive. Despite these measures and looking through the official

data released by public health organization, COVID-19 has proven itself as an unpredictable

virus, that can adapt and mutate, appearing new strings every month in different parts of the

world (WHO, 2020c).

COVID-19 pandemic has affected every aspect of society and daily life, but as the

United Nations (2020) stated, COVID-19 is not just a health crisis, but it is also affecting

societies in their basis, having a huge impact on the economy, education and in the socio-

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cultural areas of a country. Economy with high levels of unemployment, socially, with the

restrictions imposed by governments and socio-cultural activities such as cinema, theatres or

sports have been cancelled or put into stand-by due to avoid the spread of the virus. And

when it comes to education, it has been estimated that around 2.36 billion students around

the world, from early childhood education to higher education, have suffered the effects of

the pandemics in their education (Gromanda et al., 2020), including mobility restrictions,

lockdowns and school closures among others, creating a huge impact on children

development and differences between developed countries and emerging countries, as for

the last ones almost a 90% of the children have been out of the school in comparison with

developed countries where just a 20% of the children have missed school (United Nations

Development Programme, 2020) due to the difference in technological and physical

resources. Studies even present that this catastrophic situation, involving school closures and

distance education, may have cause an impact in their lifetime due to the loss of schooling,

learning opportunities and the decline on what children are learning and will learn in the

future (Hanushek & Woessmann, 2020; Kuhfeld et al., 2020). School closures has led

teachers to change the way they work and children the way they learn, from in-person

education to distance learning to continue with children development. This had brought a

reduction in the time spent by children for academic purpose and an increase in leisure

activities (Hanushek & Woessmann, 2020).

Changes in routines and practices can be a challenge for children in need of special

education. Special Education can be defined, according to the ISCED (2011), as a “designed

to facilitate the learning of individuals who, for a wide variety of reasons, require additional

support and adaptive pedagogical methods in order to participate and meet learning

objectives in an educational program” (p.83). These children may have a physical, intellectual,

or psychological condition that requires this type of education. With the ongoing pandemic,

children with special educational needs and their families will encounter additional obstacles

in their everyday life, functional limitations, and physical restrictions (Schiariti, 2020),

increased with the many barriers that have appear due governmental decisions, such as school

closures.

The shift from school-based education to distance learning has affected children with

special educational needs in a different way than mainstream schools’ students. The National

Council for Special Education (NCSE) (2014), define children with special educational needs

as those with “restrictions in their capacity to participate and benefit from education on

account of an enduring physical, sensory, mental health or learning disability, or any other

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condition which results in a person learning differently from a person without that

condition”. These children need more help in their learning process, assistance of different

trained professionals during their development and specialized physical areas to fulfil their

development (Petretto et al., 2020), making the transition to distance learning an intricate

task. The rapid adaptation to online classes has been a challenge and brought up issues for

everyone, but specially for special education and children with special educational needs

(Kaden, 2020), due to the lack of socioeconomical resources, non-supportive parents, or the

difficulties of attending online classes (Sullivan et al., 2020). The integration of children with

special educational needs caregivers in this equation has produce, as Fontanesi et al., (2020)

published is an increase on parental burnout and the feeling of being alone during the

process, due to now having to face a double job as parents and co-teachers at the same time.

In addition to this, children tend to adapt to every situation, but the ongoing pandemic has

made it difficult to children with disabilities, as it is difficult to them to understand the fast

changes that the world is experiencing (Kong & Thompson, 2020).

Therefore, this paper aims to explore the different facilitators and barriers that

children with special educational needs have found in special education during the pandemic.

1.1 Bronfenbrenner’s Bioecological Model of Human Development

The bioecological model was developed by Bronfenbrenner in different stages, having as a

result the PPCT model (Bronfenbrenner & Morris, 2006), which stands for Process-Person-

Context-Time. In this model, the main component is the process or the proximal process,

as it is the main mechanism for human development (Bronfenbrenner & Evans, 2000). This

development relies on the interaction between the person and the environment; and this

interaction is influenced by the person and its characteristics: demand, resource, and force;

the context: microsystem-mesosystem-exosystem-macrosystem; and the time: a

chronological component within the context. To state clearly why this model was selected

for the purpose of this systematic review, the process-proximal process is considered the main

concept to understand human development and how this development is achieved from the

different interactions between people. The person stands for the personal and individual

characteristics that different people display in social interactions, formed by three elements:

demand (“static” characteristics such as the age, gender, or their appearance), resource (which

are both physical-house, access to education and parental care-and psychological and

intellectual characteristics-intelligence, emotions, mental resources gain through experience)

and force (motivation and temperament). The context includes different spheres of a person’s

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interaction, being the microsystem the direct interaction with their family-work-school; the

mesosystem the interaction between the microsystems; the exosystem which are the different events

that, indirectly affects development; and macrosystem which is the culture or geographical space

where the development takes place. Time with its three elements: micro-time which stands for

the events going on during the proximal process; meso-time for the processes that occurs with a

short period of time; and macro-time for the changes occurring in a culture or geographical

place.

The decision of including this theory as a framework to this paper relies on the crucial

role that all these elements introduced by Bronfenbrenner have in everyday functioning and

will be presented with an example of the current situation that children with special

educational needs are facing. Having the PPCT model as a framework also helps to

understand which areas of the children’s environment have suffered the consequences of the

pandemic. The key concept for this paper is the macro-time as is the crucial element-COVID-

19-that has shape everyday life of children with special educational needs and has influenced

and almost, completely change every aspect of their daily life. This effect starts with the

context affecting the social, economic, and political circumstances of every country around

the world, which can be translated into the different measures taken by different

governments during the pandemic. Also, the direct relations between the children with the

school and their classmates have been affected, leaving the mesosystem as an element that is

reshaping and influencing the microsystem. As for the person, their resources and force have

completely suffered from this event, as for now resources are changing, almost, every week

with the measures imposed. Access to education, even it is a right for children, the shift to

distance learning have become a barrier to some children, due to having a physical or

psychical impairment or for the lack of access to the technology; shaping at the same time

their motivation to attend classes and learn. To conclude with Bronfenbrenner’s model,

coronavirus has affected children development and their interactions with their close

environment, family-friends-school, affecting the core of the model: proximal process.

In relation to Bronfenbrenner’s model, barriers and facilitators are expected to be

found in every element that conforms the theory due to the effects of the pandemic. Among

the PPCT theory, it is expected that barriers and facilitators will appear within, two elements

that conform the person being those the resources that every child have (such as access to

technology, family income or access to education) and force (such as the motivation on

everyday life). Being COVID-19 a general issue that has affected the context of every person,

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barriers and facilitators may appear more among the different systems that conform the child

life and that have been changed by the Time, being the COVID-19 impact on the macro-time

the responsible of the drastic change in almost all the systems that conform the context.

1.2 ICF-CY

The International Classification of Functioning, Disability and Health-Children & Youths

(ICF-CY), is a multidimensional model, that “provides a common and universal language for

clinical, public health and research applications to facilitate the documentation and

measurement of health and disability in children and youth” (WHO, 2007). This classification

tries to unify a framework to help multidisciplinary work and to code different areas that can

be affected during children and youth development. Figure 1 shows the actual classification

of the ICF-CY showing how different areas of the everyday life of a child can be analysed

and coded.

Figure 1. Structure of the ICF-CY from Simeonsson, 2009

The ICF-CY is divided into two different parts, functioning and disability (which

include: body functions, body structures, activities, and participation) and the context (which

includes environmental factors and personal factors). All these components are the core

elements that conform this model and are dynamically and reciprocally interconnect between

each other, being useful in order to describe health, functioning and disabilities in children’s

everyday life (Peterson et al., 2010).

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Body functions include the physical and psychological functioning of the body. The are

8 chapters that include different functions: mental functions; sensory function and pain;

voice and speech functions; functions of the cardiovascular, hematological, immunological

and respiratory system; digestive, metabolic and endocrine functions; genitourinary and

reproductive functions; neuromusculoskeletal and movement functions; and skin and related

structure functions (World Health Organization, 2007).

Body structures include the anatomical parts that conform the human body. These

includes 8 chapters that are related to each chapter from body functions. These structures are

nervous system; eye-ear and related structures; voice and speech structures; cardiovascular,

immunological, and respiratory system structures; digestive, metabolic and endocrine

structures; reproductive and genitourinary structures; movement structures; and skin

structures (World Health Organization, 2007).

Activity can be defined as the action carried out in order to do a task and participation

is defined as the engagement to a concrete situation. Both components are divided into 9

chapters: learning and knowledge apply; general tasks and demands; communication;

mobility; self-care; domestic life; interpersonal interactions and relationships; major life areas;

and community, social and civic life (World Health Organization, 2007).

Environmental factors are described as any physical, social, or attitudinal asset that is

found in a person environment and are divided into 5 chapters: products and technology;

natural and human shaped environment; support and relationships; attitudes; and services,

systems, and policies (World Health Organization, 2007).

Personal factors are those components of a person life that are not part of their health

condition, including personal characteristics and behavioural assets. These factors cannot be

classified due to the cultural and social difference among countries (World Health

Organization, 2007).

The reason for including the ICF-CY model as a framework for this paper relies on

the vast impact that COVID-19 has had on the environmental factors, activities and participation

and some mental functions surrounding children with special educational needs. These

components are the main elements for the purpose of this systematic review. The reason not

considering body functions, rely in the educational field where this systematic review is

settled. The ICF-CY also, serves as a great tool to classify the different elements that the

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authors may identify on their papers. These categories have a great utility to understand

where the facilitators and barriers are situated in everyday life of children with special

educational needs.

Regarding to the environmental factors the change to distance learning, the lockdowns

and policy measures, has had an effect on all the different chapters that conform it. Children

and their families had to adapt to the new distance learning education and adapt to the new

technology to fulfil their learning process. This aspect is directly affected by family’s income

and their access to technology, as not all households can afford electronic devices or internet

access. The environments in which children perform their daily life have also been affected

by the imposed lockdowns ordered by different governments and it is also related to services

and systems, they have access to. With school closures and lockdowns, children are reclused

at home and the services they used to access from school have been undermined by the

current situation. Support and relationships have also been affected by the pandemic, as all

the support they used to receive from school by a face-to-face interaction now has been

change to online support, which in some cases are not as efficient as a direct interaction. Peer

relationships have also been affected with lockdowns, as most of the children with special

needs rely on their peers for social interaction at school. In the other hand, activity, and

participation, have also been affected due to the pandemic as for the learning and knowledge

application, children have experienced a drastic change in the way they learn and how they

apply that knowledge during the pandemic. The turn to distance education may have had a

negative impact in their learning process, losing already acquired knowledge due to the lack

of interaction with their teachers or due to the difference between face-to-face learning and

online learning. Mental functions affected during the pandemic rely on the motivation or

engagement of children to the fact of the new educational model, as the shift to this new

environment may have affected the way children attend their education.

Due to the effect of the pandemic on the children’s environment it is expected to

identify most of the barriers and facilitators among this element, but they can also appear in

other areas of functioning. Following the ICF-CY describers, a barrier can be defined as a

factor that hinders the person daily life, it can obstacle the person in a great or small way and

can be avoidable or not, this also includes that barriers can be found due to its presence or

its absence (World Health Organization, 2007). Facilitators include the access to a concrete

resource, if it is a good or poor-quality facilitator or if it is a dependable or variable resource

(World Health Organization, 2007).

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2. Purpose

The purpose of this systematic review is to bring into account the barriers and facilitators

that special education students have faced during the ongoing pandemic. As this is a unique

situation this is an unexplored area of knowledge that can bring together different ideas. That

is why the research question for this paper is:

• What are the barriers and facilitators, identified by different education professionals

in previous literature, that have affected children with special educational needs,

during the COVID-19 pandemic?

3. Method

3.1 Systematic review

The method chosen to explore barriers and facilitators upon special education was a

systematic review of the literature written on the subject. A systematic literature review can

be defined, according to Jesson et al (2011)., as a method that focuses on answering a

question proposed by the researchers, which follows certain criteria such as delimiting the

inclusion and exclusion and quality assessment criteria.

3.2 Search Procedure

For the purpose of this systematic review, three databases where used: Eric, PsycInfo and

Web of Science. In addition to these databases, some of the papers included were also found

on websites of organizations such as the World Health Organization, and other papers were

found prior to searches through the databases mentioned above. During the search

procedure and since the subject matter of the paper was relatively new, Thesaurus was used

with caution since trying to make concrete searches translated into poor results or even no

results. All the searches were limited to articles published in English language. The search

words used in Eric database were Special Education AND (COVID 19 OR Coronavirus OR

COVID) and Special Education AND (Barrier or Adaptati*) AND (COVID-19 OR COVID

OR Coronavirus). This search resulted in 37 papers. The search words used in PsycInfo

database were Special education AND (COVID-19 OR COVID OR Coronavirus) and Special

Education AND (Barrier or Adaptati*) AND (COVID-19 OR COVID OR Coronavirus). This

search resulted in 56 papers. For the Web of Science database, the following search words

were used Special Education AND (COVID 19 OR Coronavirus OR COVID) and Special

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Education AND (Barrier or Adaptati*) AND (COVID-19 OR COVID OR Coronavirus). A total

of 25 papers were found. The reason of using adaptati* in the search strings was because

when the search was done using facilitator instead, not so many hints where found. So, a

decision was taken in order to increase the number of papers found during the searches.

All the searches conducted in the three different databases (ERIC, PsycInfo and Web

of Science) were refined according to the inclusion and exclusion criteria described later,

although the categories of refinement will be presented below. Databases have different

categories of refinement, but they were selected within the same topic: Special Education.

The categories of refinement used in Eric after the first search were: Special Education,

Students with Disabilities and Barriers. For PsycInfo the categories were the following:

adaptation OR psychological OR education OR risk factors OR special education students

OR childhood development OR schools OR special education OR teachers, for the first

search; for the second search: education OR barriers OR adaptation OR education OR

disabilities OR students with disabilities OR autism OR special needs students. Ultimately,

for Web of Science, these were the categories of refinement used during the searches:

education special.

Being COVID-19 an ongoing pandemic that is changing every short time, a decision

was made at the beginning of March 2021 to not accept any more paper that could be

published on the following days. All searches were conducted between January and February

2021.

3.3 Inclusion/Exclusion criteria

In order to do the screening of the chosen articles, inclusion and exclusion criteria were

established based on the research question. The purpose of this paper was to explore the

different barriers and facilitators that different special education professionals have

encountered during the COVID-19 pandemic. The focus was set on professionals that

worked or talked about children and teenagers, avoiding High Special Education. The time

frame was stated from March 2020 onwards, as COVID-19 was declared a pandemic during

that month, and papers were selected world-wide in order to broaden the searches. Inclusion

and exclusion criteria used for this review can be found in Table 1.

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Table 1. Inclusion and exclusion criteria

Inclusion Exclusion

Availability Full text available in English Other languages and abstract only

Publication Research published in databases or

world organizations

Book chapters and intervention

protocols.

Study

Design

Studies focused on opinions or

interventions done by special

education professionals.

Grey literature

All types of studies available

Studies covering special education

from other points of view

(economical or medical

perspective)

Population

Children and adolescents with special

educational needs

Teachers or professionals involved in

special education

Focused on other developmental

stages (adults or elders)

Setting Special education schools

Special education institutions

University context

Year March 2020 Research done earlier

3.4 Selection process

All the results from the search strings done in the different databases were transferred to the

online tool Rayyan QCRI (Ouzzani et al., 2016) in order to do the screening. Rayyan QCRI

is a tool designed to support, in a more efficient way, the production of systematic reviews.

The first search done in the databases ended up with a total of 118 articles. Additionally, two

more papers were found before the systematic review began. After importing 120 papers to

Rayyan QCRI, 14 were discarded for being duplicates by Rayyan QCRI. The 106 articles

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remaining were reviewed on title and abstract level. This first review was done following the

inclusion and exclusion criteria established.

3.4.1 Title and abstract

For the title and abstract screening, a total of 106 articles collected from the databases ERIC,

Web of Science and PsycInfo was transported into Rayyan QCRI. This screening was done

in order to discard those articles that clearly did not fit the basic inclusion criteria after a

title/abstract read. These excluded articles had a wrong background article, did not focus on

the population of interest, or did not cover the impact of COVID-19, among others. The

first screening concluded with 73 articles excluded for the next step, leaving 33 for full text

screening.

3.4.2 Full text

For the full text screening, the inclusion and exclusion criteria were applied again. This

screening focused on identifying barriers and/or facilitators or ways special education had

adapted during the pandemic. Out of 33 articles, 2 were duplicates that Rayyan QCRI had

not detected; 5 other articles were discarded due to being focused on the wrong population

(such as trainees, children without special needs, mainstream school teachers, etc); 2 other

articles were discarded because of their focus on very specific communities (rural native

American children with disabilities and deaf children in Greek); 1 article was excluded for

not having COVID-19 as an outcome; 7 articles were excluded for being protocol manuals

written by schools or states to address the COVID-19 crisis; 3 articles focused on advocacy

and rights of disabled people; 2 were strictly medical biased; 2 articles were a survey; and 3

articles were excluded for their background, as they did not focus on special education but

in innovations for the area (e.g., use of robots). The whole screening process can be found

in the following figure (see figure 2). This full text screening concluded with 6 articles for the

data extraction.

Figure 2. Screening Process.

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3.5 Data extraction

The data extraction protocol can be found in Appendix A. The extracted information

included basic data related to the articles such as author, year or DOI, the aim of the paper

and research questions if included, their target group and basic description of the participants

and the study design. It also includes a brief description of the barriers/facilitators faced by

students and teachers during the pandemic, in order to facilitate the identification of the

items of interest for the purpose of this paper. These items were divided into two categories

with two subgroups, one category being the teacher’s perspective of the barriers or

facilitators that children had faced and the other category being the direct barriers or

facilitators that children had faced according to the opinions of education professionals. An

important asset to consider is that, despite there being facilitators or barriers identified by

teachers, these affect directly to the children with special educational needs, being a cause-

effect interaction.

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3.6 Quality assessment

Quality assessment was performed on the chosen articles with three tools, due to the fact

that three different methodology was used on the papers. BETs checklist was done on the

quantitative-survey paper (Mackwey, Morton & Carley, n.d), CASP checklist was used on the

qualitative papers (CASP, 2018) and AACODS checklist for the grey literature (Tyndall,

2010). The selection of the tools was done by convenience, for having different study designs

upon the papers chosen and for being the best possible tools at reach and can be found on

appendix B. Since the checklists have different criteria and number of items, comparison was

made based on percentage of the criteria formed by the sum of its items. Two articles were

considered to have good quality (>80% of the criteria fulfilled), three articles have moderate

quality (>60% and <80% of the criteria fulfilled) and one have low quality (<60% of the

criteria fulfilled). Being the number of papers selected for the purpose of the search already

small, no articles were excluded. The percentages obtain can be found appendix C.

3.7 Data analysis

The data analysis in this study was done through a narrative analysis with tabulation and a

deductive approach was chosen due to the fact of having the ICF-CY as a base for the results

(Elo & Kyngäs, 2007). To answer the research question the data extracted from the papers

were coded into the different components of this manual as facilitators or barriers, depending

on how the different papers address the element. The chapters of the ICF-CY were not used

for the analysis as there are codes used by professionals to evaluate children and that was not

related to the purpose of the paper. The data was added into tables done with the different

components of the ICF-CY. In order to be included, the data should be related to the ICF-

CY description of the category.

4. Results

The following table shows a total of six articles included in the analysis of this systematic

review. All of these were able to expose different barriers and/or facilitators found that have

affected children with special educational needs. Most of these items come from education

professionals, such as special education teachers, education researchers, psychologists, and

families themselves as they have been close to their children during this period of time. All

the papers were published from March 2020 and onwards in journals related to special

education, teaching, clinical research, and others such as research institutes or information

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management journals. From the 6 papers selected, 3 were set in the USA, 1 in Europe, 1 in

India and 1 in Australia.

All six papers included in this systematic review focused directly on children that

were enrolled in special education schools and can be found on table 2, furthermore they

also brought in information related to teachers (1, 3, 5, 6). Only one paper explored the

families of these children with special educational needs (2). All six papers were settled in a

special education environment and two of them also explored mainstream schools in relation

with COVID-19 pandemic (3, 5). The methodology of the papers selected are quantitative

descriptive study (1), qualitative (3, 5, 6)-with a narrative methodology (3, 6), semi structured

interview (5) and discussion papers (2, 4)-having a document analysis (4). Regarding the aim

of the papers, six of the papers selected (1, 3, 5) addressed the issues from a digital

transformation perspective that brings in issues related to it, making this topic the key

element of the barriers identified during the pandemic. The other papers (2, 4, 6) explore the

impact of COVID-19 on children, families, and teaching from a general point of view.

The analysis is divided between facilitators and barriers, following the scheme of the

ICF-CY chapters in order to present a clear view of the findings. A definition of the chapter

will be presented in each section to clear what are different chapters about.

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Table 2

Results. Articles included for systematic review.

ID Authors Country Aim SD Focus

1 Börnert-Ringleb, M.,

Casale, G., &

Hillenbrand, C (2021)

GER Provide insights on conditions of digital learning in special

education at teacher, school, and student-levels

Quantitative-

Descriptive

Teachers/

Children/ School

2 Houtrow, A., et al., (2020) USA Discussion of the impact of COVID on children with

disabilities and their families and in their scoring systems, and

optimizing medical care and educational needs

Discussion

paper

Families/Children

3 Iivari, N., Sharma, S., &

Ventä-Olkkonen, L.

(2020)

FIN/

IN

Explore the digital transformation done in Finland

(mainstream schools) and India (Special education) through

the opinions of teachers and personnel involved in education.

Qualitative-

Narrative

Teachers/Children

4 Lund, E. M., & Gabrielli,

J. (2021)

USA Discuss several issues specific to children and adolescents with

disabilities, including (a)access to special education; (b)access

to health care and support services; (c)access to personal care;

and (d)trauma, stress, and mental health support in the context

of the pandemic.

Discussion-

Document

analysis

Children

5 Page, A., et al., (2021) AUS Identify key challenges and approaches for fostering school

connectedness when students with special educational needs

are suddenly required to be educated at distance.

Qualitative-

Semi structured

interviews

Teachers/Children

6 Smith, C. (2020) USA Explore the impact of the COVID-19 pandemic of teaching

students with disabilities

Qualitative-

Narrative

Teachers/Children

ID=Identification; SD=Study Design

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4.1 Facilitators

Few studies identified facilitators, there were only 2 papers (3, 5) that identified some sort of

facilitators and were grouped following the ICF-CY classification into two different

categories.

4.1.1 Products and technology

This section includes “natural or human-made products or systems of products, equipment

and technology in an individual’s immediate environment that are gathered, created,

produced or manufactured” (WHO, 2007).

Having access to internet (3) was identified as a facilitator for teachers, the paper

brings into account different strategies done by special education teachers in order to be

always connected to help their students, through school wi-fi, buying their own internet

access or with their own personal smartphones, tablets, or laptops. This paper (3) also

mentioned the difference between private and public schools, being public teachers the ones

who had to do more things in order to go online for attending classes.

Tablets and laptop loans were reported as a facilitator (3, 5) both for students and

teachers. Institutions, public or private, tried to ensure that all students (in this case from

India and Australia) had access to technology – via loan, in order to be able to attend class

or give lessons.

4.1.2 General tasks and demands.

Facilitators identified in this category regard routines, fit in the general tasks and demands

chapter of ICF-CY, as it is defined as “general aspects of carrying out single or multiple tasks,

organizing routines and handling stress” (WHO, 2007).

These two elements were identified (3) as a facilitator accomplished by teachers in

order to actively assure the children’s education. The new schedules were designed by

teachers through a consensus between families and other teachers in order to set timetables

for them to follow the easiest way possible, resulting in the creation of new routines for

children that had experienced an inevitable break during the pandemic. This consensus was

achieved through family meetings for evaluations (3) every week or 15 days in order to set

up goals, schedules or new routines and help parents through the education of their children.

20

4.2 Barriers

In the six papers identified, barriers where more in focus. Following the ICF-CY

categorization, barriers will be presented among their component level and the chapter where

they fit the most.

4.2.1 Products and technology

Four out of six papers identified different products and technology as barriers. of these two

identified barriers for teachers, while all 4 identified barriers for students. The barrier for

teacher regarding access to learning tools, access to internet and to technology. Barriers

identified can be found in table 3.

Table 3

Products and technology

Paper ID

1 2 3 4 5 6

Access to internet Students x x

Teachers

Access to technology Students x x x

Teachers

Access to learning tools Students x

Teachers x x

Despite having access to internet is considered a facilitator, it has also been identified

this item (2,3) as a barrier that has a direct connection with access to technology (2,3,6). But

this barrier was identified with another item that will be presented below and is related to the

socioeconomic status of families and living in rural areas. Not having an electronic device

(computer, laptop, phone, or tablet) makes it difficult for the children and their families to

remain connected to the school. Also, living in rural areas (6) makes it difficult for children

to have a good internet connection and attend their lessons. This creates a difference between

students who have resources to adapt to the situation and others that due to their living place

or family income cannot afford to have these devices for the purpose of learning.

21

Another barrier faced – both by students and teachers, were the problems to replicate

learning tools through online education. These learning tools include puzzles, games or help

tools designed to help students during their learning puzzles. Some of the authors exposed

that some of the teachers did not have the time, due to the lockdown, to get those tools from

school (3), while other teachers called out the difficulties to adapt those tools to a digital

format (5, 6).

4.2.2 Support and relationships

Four papers identified barriers related to support and relationship, defined as “people or

animals that provide practical physical or emotional support, nurturing, protection, assistance

and relationships to other persons, in their home, place of work, school or at play or in other

aspects of their daily activities” (WHO, 2007).

Table 4

Support and relationships

Paper ID

1 2 3 4 5 6

Dependence on family Students x x

Teachers x

Social isolation Students x x

Teachers

The family dependence of children with special educational needs (1,3,6), explains

the issues that children had faced during the online classes, as some of them had some kind

of disadvantage making it impossible to prepare for distance education. This means that most

of the children relied on their parents or legal tutors to help them prepare for class: preparing

the environment, giving the children what they needed for the lesson, setting on the

computer, and connecting with the teacher (3). Parent support (3) has been a crucial asset

for children during the lockdown making it a barrier for those families where their parents

could not help their children prepare for their courses due to lack of time or having to be at

work.

22

Social isolation (5,6) has been presented as a barrier for children with special needs.

The lack of peer relations for these students have had negative consequences in their

development, as for most of them their social circle relies on school and the interaction they

have with other students and special personnel that works in their centres.

4.2.3 Services

This category addresses the organizational consequences that the school closure has had on

children with special educational needs. The reason of adding this category was the

consequences of the closure of schools and the effect on the children. Loss of schooling was

identified as a barrier for children with special needs, as two of the papers (2,5) had identified

this as an issue. This barrier was presented from two different points of view, one that related

to the problem of children not going to school and making them lose milestones that had

already been achieved (2) and from the perspective of the difficulties that children had faced

during online classes that had made them fall behind in their learning process (5).

4.2.4 Access to money

Family income was presented as one of the most crucial factors that has affected children

with special educational needs during the pandemic. The income of the families has

determined if children were able to attend digital classes or not. This item was identified in

four of the papers and all authors agreed that being part of a low socioeconomic family

(2,3,5,6) had limited students in need of special support due to the lack of resources. As it

was presented before, the lack of income meant that students could not afford to have

electronic devices at their disposal, making it impossible for them to attend online classes.

Furthermore, not all of the families with children with special needs in their care had internet

connection in their homes. Most of these families struggle to make it possible for their

children to attend classes, some of them had to share their phones with children (3) but

others did not have the resources to adapt to this situation.

4.2.5 General tasks and demands.

This category is formed by several items identified and follow the line of this particular

chapter of the ICF-CY as they are related to children routines, instructions, and engagement

(see table 5).

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Table 5

General tasks and demands.

Paper ID

1 2 3 4 5 6

Change of routines Students x x x x x

Teachers x

Difficulty replicating

face-to-face instructions

Students x

Teachers x x

Lack of engagement Students x

Teachers x

Change of routines (2,3,4,5,6) was identified as a barrier for children with special

needs, as most of them had to rearrange all their schedules due the pandemic. A lot of

children, due to their parents work or their unavailability, have relied on teachers (3) to help

them create new routines, having the teachers as the one in charge of waking them up or

helping them, if possible, with online instructions. Other cases show the confusion (5) that

students have faced during the lockdown and the struggles they had in order to adapt to the

new ongoing situation. Established routines that children had before the pandemic had

created a negative effect in their daily life (2) as all their schedules had been affected and their

parents had now the responsibility to face the creation of new routines without training. In

most of the cases, children with special needs had structure protocols during their school

time, with different professionals helping them, and therefore the lockdown has made it

difficult to replicate these routines at their homes creating a barrier for children (4). This has

also been an issue for teachers (6) who had difficulties creating structured environments for

their students, as every child has their tempo, making it difficult to create a structured routine.

In the same line, teachers have faced the problem of replicating face-to-face

interactions (4,5,6) as not all the students have the same problematic and need different

things. Special mention to physical education teachers (5), who have had problems dealing

with their classes as some of the children could not attend the same way as if it had been in

a face-to-face environment. Other professionals from other fields that work with children

had the same issue as they claim that a big number of interactions with children with special

needs cannot be performed during an online meeting (4,6).

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4.2.6 Major life areas

This chapter is defined as “carrying out the tasks and actions required to engage in education,

work and employment and to conduct economic transactions” (WHO,2007). Only one item

fits in this category as it is related to the knowledge that the children acquire in different

places such at home or school and prior knowledge (1,6) was included in this category due

to it being reported with the difficulties of accessing technology. This means that a lot of

children and families had problems using laptops, computers, or tablets in order to connect

with their teachers due to the lack of training or understanding of technology, creating

problems for those who had never been habituated to the use of specific programs or at

large, with technology.

4.2.7 Mental functions

This chapter relates to the “functions of the brain: both global mental functions, such as

consciousness, energy and drive, and specific mental functions, such as memory, language

and calculation mental functions” (WHO, 2007).

Self-regulation and emotional problems (1,5) expose that children’s well-being has

been affected by the lockdown. Self-regulation problems are addressed as an issue for those

children that need extra help during their daily life, as they usually had someone near them

to guide them during their learning, but with the online method that guidance figure is not

there creating regulation problems among these children. Lack of engagement (5,6) has been

a barrier that teachers have faced the most, as they struggled on how to make children

participate more actively during the online classes and it is directly related to the motivation

of the students. This have created several issues among teachers and their way to address

students’ needs during classes in order to make their students attentive. Furthermore, families

faced the same problem, as they had to motivate their children most of the time during the

lessons as most of them could not maintain their attention to the teacher.

5. Discussion

Many professionals in different areas have struggled with addressing the problems that the

pandemic has created. In order to adjust to the fast and constant changes that have taken

place, special educators and educational institutions have had to improvise along the way to

secure the best education possible. The purpose of this systematic review was to identify

25

barriers and facilitators that children with special needs had to face after the arrival of

COVID-19 and its transformation of traditional education into digital learning. Six studies

satisfied the inclusion criteria and were considered when analysing the findings exposed

before. Facilitators (n=3) have been more related to teachers and school’s attitudes towards

children than to actual interventions from organisations while barriers (n=12) were related

to environmental factors (technology, parental and school support, attitudes, and services)

and activities or participation (change of routines that children experienced during the

pandemic).

5.1 Reflections on findings

The low number of facilitators found in the course of the review suggests that the response

to this crisis has not been as effective as intended and that part of the responsibility for this

lies with the actions taken by governments. Wang et al. (2020) highlight the incredible efforts

that teachers have made during the pandemic to meet the needs of children - both those who

worked teaching online and those who provided technological support to families to make

it easier for the students to attend classes.

One of the identified facilitators was the elaboration of new schedules – teachers

tried their best to come up with plans that fitted the individual unmet needs of their students

while involving parents in the process. Although it was part of an extraordinary effort to help

children, it appears as if it was not enough as change of routines has proven to be a

detrimental factor for them.

Findings of the analysis of each article imply that almost all the elements involved

are related to each other, especially when it comes to personal factors such as access to

money, which conditions the effects of the rest of barriers and facilitators. The income level

of families has created a disproportionate difference between children in terms of access to

certain resources – students from low-income families might not have had access to

computers or an internet connection, making online education inaccessible (Fishbane &

Tomer, 2020). In order to neutralize this specific barrier, computer loans were provided in

some countries, thus manifesting the unreadiness of certain families with children with

special needs at their care to adjust to the digital transition. On the other hand, teachers had

a hard time dealing with overcoming their student’s different needs because of schools being

closed or the lack of access to electronic devices. This led to a step backward in their learning

process and the achievements already scored up until the lockdown. Specific cases such as

26

physical activity – which relies directly on a face-to-face interaction – posed as a challenge

after the digital transition. The replication of tools or instruments such as puzzles or games

normally used in schools was another important barrier faced by special educator. The latter,

combined with the physical activity, led to a loss of motivation and engagement with the

learning process from children with special needs, which was already a problem before

COVID-19 (Page et al., 2021). This created a lot of frustration among teachers who felt they

could not provide adequate special education services to their students (Smith, 2020).

Digital transition expected that children, even those with disabilities, would be able

to rapidly adapt to the new online format. It is known that most children nowadays grew up

surrounded by technology but, as the data shows, not all of them have the resources to

develop these skills. Furthermore, some children with physical or cognitive impairment had

issues when switching to this format, as they rely on different teaching methods such as sign

language or braille to understand and interact with their surroundings (Alsadoon &

Turkestani, 2020). This proves that digital transition did not fit the needs of every child, even

when considering that children that had in fact access to technology depended on their

families to set up the computers and the environment for their classes and could not do it

themselves.

The absence of parental support was also identified as a barrier by teachers. Börnert-

Ringleb et al., (2021) state the crucial role that parental support has played in digital

implementation, not only in the learning process but also in the lack of skills and

competences with software and hardware usage (Song et al., 2020). The findings of Börnert-

Ringleb et al., (2021) also show how self-efficacy and attitudes towards digital learning are a

strong predictor of its successful use: both lack of training and knowledge of the new digital

format entail an obstacle for teachers in distance education. This is linked to a report in which

42% of the teachers claim that they struggled establishing successful online learning

environments for students with disabilities (Hamilton et al., 2020) which brings us to the

problem of self-regulation in their use of technology. Self-regulation skills are defined by

Zimmerman (2001) as "self-directive process through which learners transform their mental

abilities into task related skills". Results presented by Börnert-Ringleb et al., (2021) show that

a low perception of self-regulation skills in children can translate to less effective digital

learning process and less probability of engaging with the online environment. Such an

environment requires a high capacity for self-regulation from children with learning

difficulties or disabilities - a capacity which they themselves lack (Grigorenko et al., 2020) as

27

well as cognitive skills and motivation in order to succeed in their learning process (Bradley

et al., 2017).

Lockdowns imposed by governments made most of the world’s population face

confinement but did not affect everyone in the same way. This had a negative effect on the

social context of children with special needs since most of them rely entirely on their

relationship with peers – school means one of their life’s major areas. Page et al. (2021) brings

teachers’ concerns about how the closing of schools increases the risk of social isolation for

special education students due to their bounding/school connectedness. Smith (2020) also

brings up this point, as the loss of interaction between students and teachers has had a

negative effect on their learning process, something that was already mentioned by

Guessoum et al. (2020). Another consequence of social isolation and home reclusion were

the emotional problems that children faced during the pandemic (Page et al., 2020). Being

inside their homes with little to no outside interaction and even living with families that could

not assist them with their learning necessities has exacerbated emotional problems as anxiety

and other stressful factors that are in line with the results presented by Fontanesi et al. (2020.

Another negative effect brought by lockdowns was the drastic change of established routines

for children. Page et al., (2021) interviewed teachers and remark the negative impact that the

disruption on established routines had on children with disabilities, especially those who rely

on predictability. This confusion influenced their lack of engagement and therefore teachers

tried elaborating new plans and timetables but were frustrated by some cases in which the

children’s parents could not establish an appropriate environment for them due to the lack

of resources or time (Page et al., 2021).

5.2 Bronfenbrenner theory

Putting this into theory and as stated before, the key element of Bronfenbrenner’s theory in

relation to COVID-19 is Time, as it has shaped the rest of the concepts, such as process.

Usually, the system changes within the other elements that conform the theory and only

experiences drastic transformation when time is affected. The pandemic outbreak in 2020

triggered a massive change in, macro-time affecting globally and culturally has clearly set a big

change in the whole system of children with special educational needs. With this change, the

other aspects of PPCT (Bronfenbrenner & Morris, 2006) were affected. Starting from the

context, with all the measures taken by different governments (exosystem), affecting the

community where the children is located and having direct repercussion in their household

28

(microsystem), as well as reshaping the relations between the agents conforming those

systems (mesosystem).

The biggest impact on the children’s sphere has been identified in the context, as the

consequences of the pandemic and the measures taken by governments in their exosystem

(lockdowns, curfews, social restriction, and limited mobility among others) have created

challenges such as the parents’ workplaces that had to shut down and school’s system had to

take a fast move towards digital learning. This aspect has been exposed in most of the papers

selected for the review, as it has affected the family income. Families with economic

problems have faced an income reduction or their jobs lost, which has been a challenge when

the digital transition began. This issue has set an obstacle due to the lack of access to

technology, lack of knowledge or the problems that intrinsically has distance learning among

children with special educational needs.

Micro and mesosystem have also experienced changes caused by the pandemic.

When it comes to immediate environment, the results present that children have experienced

a step back in their milestones achieved at school. School closures have also led to an increase

in social isolation on children due to the lack of interaction with their peers. Most of these

children rely on the social support they receive at school, being this environment one of their

major life areas and the lockdowns have had a detrimental effect on them. Considering the

change in roles that both teachers and parents have been forced to take in the wake of

COVID-19 arguably have had major impact on their relationship as well, indicating that

supportive teachers and parents’ resources will impact the success of online special

education. This change of roles has given parents a bigger responsibility as educational

agents. Now they have to ensure that children are still developing their learning skills, that

they have good learning environments or try to engage them to the new digital learning.

Parents lacking resources or teachers attitudes that do not support parents’ new roles will

become major barriers to children with special educational needs education.

The person level has also experienced changes during the pandemic. On a resource

level, the barriers found have already been addressed in the discussion. Force characteristics

have been influenced by the digital, as it did not fit everyone’s situation, affecting children’s

motivation and engagement. Persistence has been affected as well due to the lack of resources

and the low motivation of some students and incentivized also by the lack of preparation or

structured lessons through the online method.

29

In the PPCT model, Bronfenbrenner emphasises the proximal processes

(Bronfenbrenner & Morris, 1998) and this process have been transformed by the pandemic.

Changes like isolation, digitalisation, reshaped relations with teachers; routines have been

hard to follow by children and changed their timetables; income has restricted opportunities

on these children towards their development. Teacher-child relation has been redefined, as

before the pandemic teachers supported in school with routines, interventions, and direct

interaction; these aspects now lay on parents, whom have different capacities and abilities.

Education therefore is relying on the support given to children on their household. On one

hand, facilitators identified in relation to this were parents’ self-efficacy and attitudes towards

digital learning, which have been helpful addressing the child’s necessities. On the other

hand, there has been a need for families to have sufficient funds, income, and knowledge to

make technology accessible, at the same time as teachers training on new technology. Child

on child relations have changed to the point where in some cases has been reduced to none

at all, impacting children’s wellbeing.

The pandemic has been a game changer for everyone, especially for children with

special educational needs. This crisis has reshaped the way we understand education, as well

as the new ways of interaction that are emerging among children with their environment,

each other, and their educational process. Education professionals should consider the

barriers and facilitators found in order to ensure a secure and healthy development in the

education of children with special needs.

5.3 Method and limitations

A systematic review has proved to be a useful tool to get an overview of what has been

written in the field of interest. It was expected not to find that many articles written about

this topic as the COVID-19 pandemic is relatively new and there has not been enough time

and resources to enquire about this subject. This has also been reflected within the type of

the studies that were found: one of the limitations of this study is the small number of papers

written during this last year, as for the current situation not all researchers have disposed of

the means to carry out investigations or have access to population to do their research. This

would be the reason why most of the papers selected were qualitative studies or discussion

papers.

30

Another limitation regarding this investigation is the fact that only one important

database related to education was chosen (Eric) so some articles may have been missed,

although the databases chosen had almost the same research published.

This systematic review has been carried out by one author which is why some of the

steps may have affected the validity of the procedure. Peer review would have increased said

validity, especially during the abstract and full text screening, meaning that some of the

articles that were excluded might have suited the inclusion criteria.

Another limitation can be the search terms used in the different databases – being

the study focus such a narrow topic made the author limit as much as possible the searches

to avoid intrusive papers from other fields such as medical or sociological areas.

Finally, one of the most important limitations encountered during the conduct of

this study and that escapes the control of the author is the exposure: COVID-19. The virus

is changing every day and making governments, institutions, and people adapt rapidly to the

upcoming situations, meaning that the results presented in this systematic review may change

in the upcoming months.

5.4 Future research

There are several implications for future research based on the results of this papers. An

important asset is the high number of barriers identified compared to facilitators, making

this difference a possible line of study for future investigations. Following this line, another

interesting research could be, despite the big changes that the pandemic has created, to

determine if mainstream schools have faced the same barriers as special education schools,

in order to explore what could have be done to address the obstacles faced by children with

special educational needs.

6. Conclusion

The pandemic has brought a drastic change in our lives and most governments have tried to

manage the situation, sometimes well and sometimes not; but measures covering all aspects

of society have not yet been adequately covered. The pandemic is a long-term problem that

will bring changes in our daily lives. Despite the ongoing vaccination programme, the

economic, cultural, social, and personal effects will be seen in the coming years. A number

of barriers and facilitators were identified as elements that have affected children with special

31

educational needs during this past year. Most of the barriers encountered appeared to be

interrelated, showing that a single barrier can cause others to affect children's development.

To address these barriers and try to overcome the challenges they pose, efforts must be made

at higher levels of society, such as policies, laws, or government support, to ensure the proper

development of children.

32

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Appendix A

Table 6.

Data extraction protocol

Question: Answer

Author:

Tittle:

Journal:

Year:

DOI/ACCESS

Aim:

Research Question:

Hypothesis:

Target Group:

Participants recruited:

Sampling:

Number:

Gender:

Age:

Design and type:

Data collection method:

Barriers for teachers:

Barriers for students:

Adaptation from teachers:

Adaptation from special students:

Interesting papers

39

Appendix B

Table 7

BestBETs SURVEY (INCLUDING PRE-TEST PROBABILITIES) CHECKLIST

How do you rate this paper? 1 2 3 4 5 6 7 8 9 10

Category Subcategory

Objectives and

hypothesis

Are the objectives of the study clearly stated?

Design Is the study design suitable for the objectives?

Who/what was studied?

Was this the right sample to answer the objectives?

Did the subject represent the full spectrum of the population of

interest?

Is the study large enough to achieve its objectives? Have sample size

estimates been performed?

Were all subjects accounted for?

Were all appropriate outcomes considered?

Has ethical approval been obtained if appropriate?

What measures were made to contact non-responders?

What was the response rate?

Measurement

and

observation

Is it clear what was measured, how it was measured and what the

outcomes were?

Are the measurements valid?

Are the measurements reliable?

Are the measurements reproducible?

Results Are the basic data adequately described?

Are the results presented clearly, objectively and in sufficient detail to

enable readers to make their own judgement?

Are the results internally consistent, i.e.do the numbers add up

properly?

Analysis Are the data suitable for analysis?

Are the methods appropriate to the data?

Are any statistics correctly performed and interpreted?

40

Discussion Are the results discussed in relation to existing knowledge on the

subject and study objectives?

Is the discussion biased?

Can the results be generalised?

Interpretation Are the authors’ conclusions justified by the data?

What level of evidence has this paper presented? (using CEBM levels)

Does this paper help me answer my problem?

How do you rate this paper now? 1 2 3 4 5 6 7 8 9 10

Table 8.

CASP checklist for qualitative papers

Section Questions

Are the results of the

study valid?

Was there a clear statement of the aims of the research?

Is a qualitative methodology appropriate?

Was the research design appropriate to address the aims of the

research?

Was the recruitment strategy appropriate to the aims of the

research?

Was the data collected in a way that addressed the research

issue?

Has the relationship between researcher and participants been

adequately considered?

What are the results? Have ethical issues been taken into consideration?

Was the data analysis sufficiently rigorous?

Is there a clear statement of findings?

Will the results help

locally?

How valuable is the research?

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Table 9

AACODS checklist for grey literature

Category Subcategory

Authority Individual author:

Associated with a reputable organisation?

Professional qualifications or considerable experience?

Produced/published other work (grey/black) in the field?

Recognised expert, identified in other sources?

Cited by others? (use Google Scholar as a quick check)

Higher degree student under “expert” supervision?

Organisation or group:

Is the organisation reputable? (e.g. W.H.O)

Is the organisation an authority in the field?

In all cases:

Does the item have a detailed reference list or bibliography?

Accuracy Does the item have a clearly stated aim or brief?

Is so, is this met?

Does it have a stated methodology?

If so, is it adhered to?

Has it been peer-reviewed?

Has it been edited by a reputable authority?

Supported by authoritative, documented references or credible

sources?

Is it representative of work in the field?

If No, is it a valid counterbalance?

Is any data collection explicit and appropriate for the research?

If item is secondary material (e.g. a policy brief of a technical report)

refer to the original. Is it an accurate, unbiased interpretation or

analysis?

Coverage Are any limits clearly stated?

Objectivity Opinion, expert or otherwise, is still opinion: is the author’s standpoint

clear?

Does the work seem to be balanced in presentation?

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Date Does the item have a clearly stated date related to content? No easily

discernible date is a strong concern.

If no date is given, but can be closely ascertained, is there a valid reason

for its absence?

Check the bibliography: have key contemporary material been included?

Significance Is the item meaningful? (this incorporates feasibility, utility, and

relevance)

Does it add context?

Does it enrich or add something unique to the research?

Does it strengthen or refute a current position?

Would the research area be lesser without it?

Is it integral, representative, typical?

Does it have impact? (in the sense of influencing the work or behaviour

of others)

Table 10

CASP Checklist Results

Paper ID Paper 3 Paper 5 Paper 6

Item 1 Yes Yes Yes

Item 2 Yes Yes CT

Item 3 Yes Yes CT

Item 4 Yes Yes Yes

Item 5 CT Yes Yes

Item 6 CT Yes Yes

Item 7 CT Yes Yes

Item 8 CT Yes Yes

Item 9 Yes CT CT

Total Quality 55% 88% 67%

CT = Can’t Tell

43

Table 10.

AAOCD Checklist Results

Category Paper 2 Paper 4 Quality

Authority 7/9 8/9 In order to address the quality of the grey literature, the assignment of a quality grade

was done according to the fulfilments of each category. A scale of assessment was as

assigned when the items at least fulfilled a 60% of the category.

For each category, the items obtained were divided by the total number of items, then

a sum was made with all the categories and it was compared with the total percentage

of the checklist (6=100%).

This resulted in paper 2 quality being 73.66% and paper 4 quality 73.83 %

Accuracy 8/10 7/10

Coverage 0/1 0/1

Objectivity 2/2 2/2

Date 2/2 2/2

Significance 6/7 6/7

44

Table 11

BestBETs Checklist Results

Category Paper 1 Quality

Objective and hypothesis 1/1 In order to give a percentage to this quantitative

paper, the same method used for grey literature was

applied. The items obtained were divided by total

number of items in each category and compared to

the total number of categories that the checklist has.

This resulted in paper 1 quality being 84.85%

Design 5/8

Measurement 4/4

Results 3/3

Analysis 3/3

Discussion 2/3

Interpretation 2/3